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Coding Data Quality Auditor

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Work at Home, Illinois

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Category:
IT - Administration

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Contract Type:
Not provided

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Salary:

18.50 - 38.82 USD / Hour
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Job Description:

Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.

Job Responsibility:

  • Perform audit and abstraction of medical records to identify and submit ICD codes for risk adjustment
  • Ensure codes are appropriate, accurate, and supported by clinical documentation
  • Support coding judgment and decisions using industry standard evidence and tools
  • Abstraction and assignment of accurate medical codes for diagnoses
  • Sound knowledge of coding guidelines and regulations
  • Identify clinically active vs. historical conditions
  • Utilize medical records to ensure support for etiology and manifestations of disease processes
  • Adhere to stringent timelines
  • Conduct self-process audits for compliance

Requirements:

  • Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
  • CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required
  • Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
  • Experience with International Classification of Disease (ICD) codes required

Nice to have:

  • CRC (Certified Risk Adjustment Coder)
  • Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC)
What we offer:
  • Medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • bonus, commission or short-term incentive program

Additional Information:

Job Posted:
April 24, 2026

Expiration:
May 05, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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